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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Cash flows from operating activities |  |  |
Net income | $ 17,673,317 | $ 60,267,491 | $ 45,824,328
Adjustments to reconcile net income to net cash provided by operating activities: |  |  |
Depreciation and amortization | 18,753,270 | 19,303,179 | 19,075,353
Loss on disposal of property and equipment | 0 | 41,784 | 0
Impairment of goodwill and intangible assets | 1,994,000 | 3,798,866 | 2,431,791
Provision for doubtful accounts | (1,363,363) | 3,887,647 | 0
Share-based compensation | 1,546,861 | 1,441,089 | 2,743,116
Gain on loan assumption | (2,250,000) | 0 | 0
Unrealized (gain) loss from investment in equity securities | (9,119) | 25,005 | (86,005)
Gain on settlement of preexisting note receivable from ApolloMed | 0 | 0 | (921,938)
Gain from investments – fair value adjustments | 0 | 0 | (13,697,018)
Change in fair value of derivative instrument | 0 | 0 | 44,886
Loss from equity method investments | 6,900,859 | 8,125,285 | 1,112,541
Deferred tax | (6,800,919) | (8,345,235) | (20,675,807)
Changes in operating assets and liabilities, net of acquisition amounts: |  |  |
Receivable, net | 10,713,803 | (263,191) | 4,108,970
Receivable, net – related parties | (1,435,306) | (28,363,108) | 6,593,783
Other receivable | (15,079,346) | 0 | 0
Prepaid expenses and other current assets | (2,755,599) | (2,813,564) | 1,260,064
Right-of-use assets | 2,479,862 |  |
Other assets | (572,213) | 2,446 | (220,925)
Accounts payable and accrued expenses | (4,883,243) | (22,669,230) | (3,687,022)
Fiduciary accounts payable | 488,483 | 0 | 0
Capitation incentives payable | 0 | (21,500,000) | 1,878,355
Medical liabilities | (2,391,459) | 4,134,209 | 5,661,313
Income taxes payable | (7,092,994) | 8,423,366 | 388,138
Operating lease liabilities | (2,243,511) |  |
Net cash provided by operating activities | 13,673,383 | 25,496,039 | 51,833,923
Cash flows from investing activities |  |  |
Cash acquired from Merger | 0 | 0 | 37,112,775
Cash received from consolidation of VIE | 0 | 0 | 228,287
Purchases of marketable securities | (115,402,452) | (9,013) | (5,283)
Proceeds from loan receivable | 0 | 0 | 200,000
Advances on loans receivable | (11,425,000) | (7,500,000) | (10,000,000)
Dividends received from equity method investments | 240,000 | 607,411 | 1,240,000
Proceeds on sale of investments in a privately held entity | 0 | 0 | 25,000
Payments for business acquisitions, net of cash acquired | (49,402,514) | 0 | 0
Purchases of investments in privately held entities | (491,000) | (405,000) | 0
Purchases of investments – equity method | (3,108,000) | (16,706,152) | 0
Purchases of property and equipment | (1,041,670) | (1,170,064) | (2,084,770)
Net cash (used in) provided by investing activities | (180,630,636) | (25,182,818) | 26,716,009
Cash flows from financing activities |  |  |
Dividends paid | (61,717,367) | (17,758,808) | (10,447,923)
Change in noncontrolling interest capital | 27,500 | 27,300 | 0
Borrowings on long-term debt | 250,000,000 | 8,000,000 | 5,000,000
Borrowings on line of credit | 39,600,000 | 0 | 0
Advances by NMM to ApolloMed prior to the Merger | 0 | 0 | (9,000,000)
Repayments on long-term debt | (2,375,000) | 0 | 0
Repayments on bank loan, and lines of credit | (52,640,258) | (495,134) | 0
Payment of capital lease obligations | (101,741) | (98,735) | (102,348)
Proceeds from exercise of stock options included in liabilities | 0 | 0 | 425,025
Proceeds from exercise of stock options and warrants | 3,123,709 | 3,996,677 | 164,797
Proceeds from common stock offering | 754,998 | 200,000 | 2,160,736
Repurchase of common shares | (7,569,685) | (5,047,643) | (3,175,836)
Cost of debt and equity issuances | (5,771,444) | 0 | 0
Net cash used in financing activities | 163,330,712 | (11,176,343) | (14,975,549)
Net (decrease) increase in cash, cash equivalents and restricted cash | (3,626,541) | (10,863,122) | 63,574,383
Cash, cash equivalents and restricted cash, beginning of year | 107,636,973 | 118,500,095 | 54,925,712
Cash, cash equivalents and restricted cash, end of year | 104,010,432 | 107,636,973 | 118,500,095
Supplemental disclosures of cash flow information |  |  |
Cash paid for income taxes | 20,200,000 | 23,642,662 | 24,362,223
Cash paid for interest | 4,257,536 | 462,336 | 51,043
Supplemental disclosures of non-cash investing and financing activities |  |  |
Cashless exercise of stock options | 0 | 109 | 0
Deferred tax liability adjusted to goodwill | 6,334,368 | 1,110,456 | 0
Reclassification of liability for equity shares | 1,185,025 | 0 | 0
Purchase price adjustment for acceleration of vested stock options | 0 | 868,000 | 0
Conversion of loan receivable to investment in Accountable Health Care, IPA | 0 | 5,000,000 | 0
Reclassification of dividends related to share repurchase | 0 | 4,216,202 | 0
Reclassification of APS noncontrolling interest to equity related to purchase of additional shares | 0 | 2,832,180 | 0
Distribution of warrants to former NMM shareholders | 0 | 0 | 5,294,000
Issuance of common stock upon conversion of debt and accrued interest | 0 | 0 | 5,376,215
Reclassification of liability for unissued common shares payable to equity | 0 | 0 | 1,237,650
Non-cash purchase consideration for acquisition | 0 | 0 | 61,092,050
Reconciliation of cash, cash equivalents, and restricted cash |  |  |
Cash and cash equivalents | 103,189,328 | 106,891,503 | 99,749,199
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows | 104,010,432 | 107,636,973 | 118,500,095
Unvested stock compensation |  |  |
Supplemental disclosures of non-cash investing and financing activities |  |  |
Non-cash purchase consideration for acquisition | 0 | 0 | 187,333
NMM |  |  |
Supplemental disclosures of non-cash investing and financing activities |  |  |
Non-cash purchase consideration for acquisition | 0 | 0 | 5,129,000
Preferred stock |  |  |
Supplemental disclosures of non-cash investing and financing activities |  |  |
Non-cash purchase consideration for acquisition | 0 | 0 | 19,118,000
Affiliated Entity | APC |  |  |
Supplemental disclosures of non-cash investing and financing activities |  |  |
APC stock issued in exchange for AMG | $ 414,250 | $ 0 | $ 0

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